This document supplements our Salaried and Non-Union Hourly Health and Welfare Plan Documents.
Eligible employees who work for a covered employer can take up to 12 weeks of unpaid, job-protected leave in a 12-month period
for the following reasons:
- The birth of a child or placement of a child for adoption or foster care;
- To bond with a child (leave must be taken within 1 year of the child’s birth or placement);
- To care for the employee’s spouse, child, or parent who has a qualifying serious health condition;
- For the employee’s own qualifying serious health condition that makes the employee unable to perform the employee’s job;
- For qualifying exigencies related to the foreign deployment of a military member who is the employee’s spouse, child, or parent.
An eligible employee who is a covered servicemember’s spouse, child, parent, or next of kin may also take up to 26 weeks of FMLA leave in a single 12-month period to care for the servicemember with a serious injury or illness.
An employee does not need to use leave in one block. When it is medically necessary or otherwise permitted, employees may take leave intermittently or on a reduced schedule.
Employer may require, use of accrued paid leave while taking FMLA leave. If an employee substitutes accrued paid leave for FMLA leave, the employee must comply with the employer’s normal paid leave policies.
BENEFITS & PROTECTIONS
While employees are on FMLA leave, employers must continue health insurance coverage as if the employees were not on leave.
Upon return from FMLA leave, most employees must be restored to the same job or one nearly identical to it with
equivalent pay, benefits, and other employment terms and conditions.
An employer may not interfere with an individual’s FMLA rights or retaliate against someone for using or trying to use FMLA leave,
opposing any practice made unlawful by the FMLA, or being involved in any proceeding under or related to the FMLA.
An employee who works for a covered employer must meet three criteria in order to be eligible for FMLA leave. The employee must:
- Have worked for the employer for at least 12 months;
- Have at least 1,250 hours of service in the 12 months before taking leave;* and
- Work at a location where the employer has at least 50 employees within 75 miles of the employee’s worksite.
Generally, employees must give 30-days’ advance notice of the need for FMLA leave. If it is not possible to give 30-days’ notice, an employee must notify the employer as soon as possible and, generally, follow the employer’s usual procedures.
Employees do not have to share a medical diagnosis, but must provide enough information to the employer so it can determine if the leave qualifies for FMLA protection. Sufficient information could include informing an employer that the employee is or will be unable to perform his or her job functions, that a family member cannot perform daily activities, or that hospitalization or continuing medical treatment is necessary. Employees must inform the employer if the need for leave is for a reason for which FMLA leave was previously taken or certified.
Employers can require a certification or periodic recertification supporting the need for leave. If the employer determines that the certification is incomplete, it must provide a written notice indicating what additional information is required.
Once an employer becomes aware that an employee’s need for leave is for a reason that may qualify under the FMLA, the employer must notify the employee if he or she is eligible for FMLA leave and, if eligible, must also provide a notice of rights and responsibilities under the FMLA. If the employee is not eligible, the employer must provide a reason for ineligibility.
Employers must notify its employees if leave will be designated as FMLA leave, and if so, how much leave will be designated as FMLA leave.
Employees may file a complaint with the U.S. Department of Labor, Wage and Hour Division, or may bring a private lawsuit against an employer.
The FMLA does not affect any federal or state law prohibiting discrimination or supersede any state or local law or collective bargaining agreement that provides greater family or medical leave rights.
Important Information About Your COBRA Continuation Coverage Rights
What is continuation coverage?
Federal law requires that most group health plans (including this Plan) give employees and their families the opportunity to continue their health care coverage when there is a “qualifying event” that would result in a loss of coverage under an employer’s plan. Depending on the type of qualifying event, “qualified beneficiaries” can include the employee (or retired employee) covered under the group health plan, the covered employee’s spouse, and the dependent children of the covered employee.
Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the Plan who are not receiving continuation coverage. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan, including open enrollment and special enrollment rights.
How long will continuation coverage last?
In the case of a loss of coverage due to end of employment or reduction in hours of employment, coverage generally may be continued for up to a total of 18 months. In the case of losses of coverage due to an employee’s death, divorce or legal separation, the employee’s becoming entitled to Medicare benefits or a dependent child ceasing to be a dependent under the terms of the plan, coverage may be continued for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. This notice shows the maximum period of continuation coverage available to the qualified beneficiaries.
Continuation coverage will be terminated before the end of the maximum period if:
- any required premium is not paid in full on time;
- a qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary (note: there are limitations on plans’ imposing a preexisting condition exclusion and such exclusions will become prohibited beginning in 2014 under the Affordable Care Act);
- a qualified beneficiary becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage; or
- the employer ceases to provide any group health plan for its employees.
Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud).
How can you extend the length of COBRA continuation coverage?
If you elect continuation coverage, an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. You must notify MarketLink [Barnes Group’s COBRA Administrator] of a disability or a second qualifying event in order to extend the period of continuation coverage. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage.
An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined by the Social Security Administration (SSA) to be disabled. The disability has to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must notify MarketLink [Barnes Group’s COBRA Administrator] is you become qualified disabled under SSA and provide all supporting documents as evidence of such approval, within 30 days of SSA’s determination. Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. If the qualified beneficiary is determined by SSA to no longer be disabled, you must notify the Plan of that fact within 30 days after SSA’s determination.
Second Qualifying Event
An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. Such second qualifying events may include the death of a covered employee, divorce or separation from the covered employee, the covered employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan. These events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Plan if the first qualifying event had not occurred. You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your continuation coverage.
How can you elect COBRA continuation coverage?
To elect continuation coverage, you must complete the Election Form and furnish it according to the directions on the form. Each qualified beneficiary has a separate right to elect continuation coverage. For example, the employee’s spouse may elect continuation coverage even if the employee does not. Continuation coverage may be elected for only one, several, or for all dependent children who are qualified beneficiaries. A parent may elect to continue coverage on behalf of any dependent children. The employee or the employee's spouse can elect continuation coverage on behalf of all of the qualified beneficiaries.
In considering whether to elect continuation coverage, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying event listed above. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you.
How much does COBRA continuation coverage cost?
Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or, in the case of an extension of continuation coverage due to a disability, 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. The required payment for each continuation coverage period for each option is described in this notice.
When and how must payment for COBRA continuation coverage be made?
First payment for continuation coverage
If you elect continuation coverage, you do not have to send any payment with the Election Form. However, you must make your first payment for continuation coverage not later than 45 days after the date of your election. (This is the date the Election Notice is post-marked, if mailed). If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election, you will lose all continuation coverage rights under the Plan. You are responsible for making sure that the amount of your first payment is correct. You may contact MarketLink [Barnes Group’s COBRA Administrator] to confirm the correct amount of your first payment.
Periodic payments for continuation coverage
After you make your first payment for continuation coverage, you will be required to make periodic payments for each subsequent coverage period. The amount due for each coverage period for each qualified beneficiary is shown in this notice. The periodic payments can be made on a monthly basis. Under the Plan, each of these periodic payments for continuation coverage is due no later than 30 days from the due date. If you make a periodic payment on or before the first day of the coverage period to which it applies, your coverage under the Plan will continue for that coverage period without any break. The Plan will not send periodic notices of payments due for these coverage periods.
Grace periods for periodic payments
Although periodic payments are due on the dates shown above, you will be given a grace period of 30 days after the first day of the coverage period to make each periodic payment. Your continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. However, if you pay a periodic payment later than the first day of the coverage period to which it applies, but before the end of the grace period for the coverage period, your coverage under the Plan will be suspended as of the first day of the coverage period and then retroactively reinstated (going back to the first day of the coverage period) when the periodic payment is received. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated.
If you fail to make a periodic payment before the end of the grace period for that coverage period, you will lose all rights to continuation coverage under the Plan.
Your first payment and all periodic payments for continuation coverage should be sent to:
MARSH & MCLENNON AGENCY / MMA MARKETLINK
2300 Renaissance Blvd.
King of Prussia, PA 19406
Attn: COBRA Unit
For more information
This notice does not fully describe continuation coverage or other rights under the Plan. More information about continuation coverage and your rights under the Plan is available in your summary plan description or from the Plan Administrator.
If you have any questions concerning the information in this notice, your rights to coverage, or if you want a copy of your summary plan description, you should contact Marsh & McLennon Agency / MMA Marketlink [COBRA Administrator] at 2300 Renaissance Blvd., King of Prussia, PA 19406 or by calling (800) 580-6854.
For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, visit the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) website at www.dol.gov/ebsa or call their toll-free number at 1-866-444-3272 For more information about health insurance options available through a Health Insurance Marketplace, visit www.healthcare.gov.
Keep Your Plan Informed of Address Changes
In order to protect your and your family’s rights, you should keep the Plan Administrator informed of any changes in your address and the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately four minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of the Chief Information Officer, Attention: Departmental Clearance Officer, 200 Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email DOL_PRA_PUBLIC@dol.gov and reference the OMB Control Number 1210-0123.
Important Notice of Creditable Coverage from Barnes Group Inc.
Your Active Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your Barnes Group Inc. prescription drug benefits and the prescription drug coverage available for individuals with Medicare.
This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
Barnes Group Inc. has determined that the prescription drug coverage offered by the company is considered to be Creditable Coverage. This means that the amount that the plan expects to pay on average for prescription drugs for individuals covered by the plan in 2021 is as much as or greater than what the standard Medicare Part D prescription drug coverage would be expected to pay on average. Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and avoid having to pay extra if you later decide to enroll in Medicare Part D prescription drug coverage.
If you decide to enroll in a Medicare prescription drug plan and drop your Barnes Group Inc. prescription drug coverage, be aware that you and your dependents will be able to re-join the Barnes Group plan during annual open enrollment or if you experience a change in family status. Please contact us for more information about what happens to your coverage if you enroll in a Medicare Part D prescription drug plan.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15 through December 7. However, if you lose your current creditable prescription drug coverage through no fault of your own, you will also be eligible for a two-month Special Enrollment Period to sign up for a Medicare prescription drug plan without penalty.
You should also know that if you drop or lose your creditable coverage with Barnes Group Inc. and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.
If you go 63 continuous days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, and during that time you are eligible to participate in a Medicare Part D prescription drug plan, your monthly premium may go up at least 1% per month for every month that you did not have that coverage.
For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll.
For more information about this notice or your current prescription drug coverage…
Contact the Barnes Group Inc. appointed representative listed below. NOTE: You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Barnes Group Inc. changes. You also may request a copy of this notice at any time.
For more information about your Medicare prescription drug coverage options…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans:
- Visit www.medicare.gov;
- Call your State Health Insurance Assistance Program (see your copy of the “Medicare & You” handbook for the telephone number) for personalized help;
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the prescription drug plans approved by Medicare, you may be required to provide a copy of this notice when you join.
Name of Entity:
Barnes Group Inc.
Lynne P. Knittel
Barnes Group Inc.
123 Main Street
Bristol, CT 06010
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and patient:
- All stages of reconstruction of the breast on which the mastectomy has been performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedemas.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan. For more information, contact the Plan Administrator at:
Barnes Group Inc.
123 Main Street
Bristol, CT 06010
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
If you have questions about enrolling in your employer plan, contact the Department of Labor at www.dol.gov/agencies/ebsa or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 1, 2021. Contact your State for more information on eligibility.
|ALABAMA – Medicaid|
|ALASKA – Medicaid|
The AK Health Insurance Premium Payment Program
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
|ARKANSAS - Medicaid|
|COLORADO – Medicaid|
Health First Colorado Website: https://www.healthfirstcolorado.com/
Phone: 1-800-221-3943 / State Relay 711
CHP+ Customer Service Phone: 1-800-359-1991
|FLORIDA – Medicaid|
|GEORGIA – Medicaid|
Phone: 678-564-1162, ext. 2131
|INDIANA – Medicaid|
Healthy Indiana Plan for low-income adults 19-64
|IOWA – Medicaid|
Medicaid Phone: 1-800-338-8366
Hawki Website: https://dhs.iwoa.gov/Hawki
Hawki Phone: 1-800-257-8563
|KANSAS - Medicaid|
KanCare Website: https://www.kancare.ks.gov/
|KENTUCKY - Medicaid|
Kentucky Integrated Health Insurance Premium Payment Program
KI HIPP Website: https://chfs.ky.gov/agencies/dms/member/pages/kihipp.aspx
|MAINE - Medicaid|
|MASSACHUSETTS - Medicaid and CHIP|
|MINNESOTA - Medicaid|
Website: https://www.benefits.gov/benefit/1286, or https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp
Phone: 1-800-366-5411 or 1-800-657-3739
|MISSOURI - Medicaid|
|MONTANA – Medicaid|
|NEBRASKA – Medicaid|
Phone (Lincoln): 1-402-473-7000
Phone (Omaha): 1-402-595-1178
|NEVADA – Medicaid|
|Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-877-638-3472
|NEW HAMPSHIRE – Medicaid|
Phone: 603-271-5218 or 1-800-852-3345, ext. 5218
|NEW JERSEY – Medicaid and CHIP|
|Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/
Medicaid Phone: 1-800-356-1561
CHIP Website: http://www.njfamilycare.org/default.aspx
CHIP Phone: 1-800-701-0710
|NEW YORK – Medicaid|
|NORTH CAROLINA – Medicaid|
|NORTH DAKOTA – Medicaid|
|OKLAHOMA – Medicaid and CHIP|
|OREGON - Medicaid|
|PENNSYLVANIA - Medicaid|
|RHODE ISLAND - Medicaid|
|SOUTH CAROLINA - Medicaid|
|SOUTH DAKOTA - Medicaid|
|TEXAS - Medicaid|
Phone: 1-800-440-0493 or 1-800-335-8957
|UTAH - Medicaid and CHIP|
|Medicaid Website: http://medicaid.utah.gov
Medicaid Phone: 1-801-538-6155
CHIP Website: http://health.utah.gov/chip
|VERMONT - Medicaid|
|VIRGINIA - Medicaid and CHIP|
Medicaid Website: https://www.dmas.virginia.gov/for-applicants/
Medicaid Phone: 1-855-242-8282
CHIP Website: https://coverva.org/en/famis
CHIP Phone: 1-888-221-1590
|WASHINGTON – Medicaid|
|WEST VIRGINIA - Medicaid|
|WISCONSIN – Medicaid|
|Website: https://www.dhs.wisconsin.gov/medicaid/index.htm or
|WYOMING - Medicaid|
Your health plan is committed to helping you achieve your best health. A voluntary wellness program is offered to all employees. The wellness program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others.
If you choose to participate in the wellness program you may be asked to complete a voluntary health risk assessment or "HRA" that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease), to complete certain screenings or to undertake other health tests. Please refer to the wellness program documents provided at open enrollment for full information on the medical information that will be collected if you choose to participate in the wellness program.
Rewards for participating in the wellness program are available to employees. Please refer to the wellness program documents available on this website for full information on the available incentives and rewards. If you think you might be unable to meet a standard for a reward under the wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact the Plan Administrator at: Barnes Group Inc., 123 Main Street, Bristol, CT 06010, (860) 583-7070 and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.
We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program provider and Barnes Group Inc. may use aggregate information it collects to design a program based on identified health risks in the workplace, the wellness program provider will never disclose any of your personal information either publicly or to your employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you and that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individuals who will receive your personally identifiable health information are certain representatives of the wellness program provider (such as your health coach), who need the information in order to provide you with services under the wellness program.
In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.
You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.
If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the Plan Administrator at:
Barnes Group Inc.
123 Main Street
Bristol, CT 06010
THIS NOTICE DESCRIBES HOW HEALTH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: The original effective date of this Notice is April 14, 2003. The Notice was subsequently amended to reflect certain material changes effective as of October 1, 2017.
GENERAL INFORMATION REGARDING THIS NOTICE
Barnes Group Inc. continues its commitment to maintaining the confidentiality of your private medical information. This Notice describes the legal obligations of the group dental and health plans maintained by Barnes Group Inc. (each a “BGI Health Plan” and collectively, the "BGI Health Plans”) imposed by the Health Insurance Portability and Accountability Act of 1996, the American Recovery and Reinvestment Act of 2009 and accompanying regulations (the “Privacy Rules”) regarding your health information. The Privacy Rules require that the BGI Health Plans use and disclose your health information only as described in this Notice.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
The BGI Health Plans may use your health information, that is, information that constitutes “protected health information,” for purposes of making or obtaining payment for your care and conducting health care operations. Protected health information is defined in the Privacy Rule as health information (including genetic information) that can be used to identify you or for which there is a reasonable basis to believe it can be used to identify you, and that relates to: (1) your past, present or future physical or mental health condition, (2) the provision of health care to you, or (3) the past, present or future payment for your health care. This may include individual identifiable health information that includes many common identifiers, such as your name, address, birth date, or Social Security Number. The BGI Health Plans have established a policy to guard against unnecessary disclosure of your protected health information.
The BGI Health Plans are required to: (1) ensure that health information that identifies you is kept private, except as such information is required or permitted to be disclosed by law, (2) describe the legal duties and privacy practices of the BGI Health Plans with respect to your protected health information, (3) abide by the terms of this Notice that are currently in effect, and (4) notify affected individuals following a breach of unsecured protected health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED BY THE BGI HEALTH PLANS:
To Make or Obtain Payment. A BGI Health Plan may use or disclose your protected health information to make payment to or collect payment from third parties, such as other BGI Health Plans or health care providers, for the care you receive. For example, BGI Health Plans may provide information regarding your coverage or health care treatment to other BGI Health Plans to coordinate payment of benefits. We may also disclose protected health information to another group health plan or health care provider for their payment purposes. For example, we may exchange your protected health information with your spouse’s health plan for coordination of benefits purposes.
To Conduct Health Care Operations. A BGI Health Plan may use or disclose protected health information for its own operations, to facilitate the administration of the BGI Health Plans, and as otherwise necessary to provide coverage and services to all of the BGI Health Plans' participants. For example, we may conduct activities such as:
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care costs.
- Clinical guideline and protocol development, case management and care coordination.
- Contacting health care providers and participants with information about treatment alternatives and other related functions.
- Health care professional competence or qualifications review and performance evaluation.
- Accreditation, certification, licensing or credentialing activities.
- Underwriting, premium rating or related functions to create, renew or replace health insurance or health benefits.
- Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
- Business planning and development including cost management and planning related analyses and formulary development.
- Business management and general administrative activities of the BGI Health Plans, including customer service and resolution of internal grievances.
For Treatment. The BGI Health Plans may use and disclose your protected health information to facilitate medical treatment or services by providers. For example, we might disclose information about your prior prescriptions to a pharmacist to determine if prior prescriptions contraindicate a pending prescription.
For Disclosure to the Plan Sponsor. The BGI Health Plans may disclose your protected health information to the plan sponsor for plan administration functions performed by the plan sponsor on behalf of the BGI Health Plans. In addition, the BGI Health Plans may provide summary health information to the plan sponsor so that the plan sponsor may solicit premium bids from health insurers or modify, amend or terminate the plan. The BGI Health Plans also may disclose to the plan sponsor information on whether you are participating in any BGI Health Plans.
However, your protected health information cannot be used for employment purposes without your specific authorization. And in no event will we use or disclose protected health information that is “genetic information” (as defined under the Genetic Information Nondiscrimination Act of 2008) for underwriting purposes. In addition to rating and pricing a group insurance policy, this means the BGI Health Plans may not use genetic information (including that requested or collected in a health risk assessment or wellness program) for setting deductibles or other cost sharing mechanisms, determining premiums or other contribution amounts, or applying preexisting condition exclusions.
When Legally Required. The BGI Health Plans will disclose your protected health information when it is required to do so by any federal, state or local law. For example, we may disclose your protected health information when required by national security laws or public health disclosure laws.
To Conduct Health Oversight Activities. The BGI Health Plans may disclose your protected health information to a health oversight agency for authorized activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. The BGI Health Plans, however, may not disclose your protected health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.
In Connection with Judicial and Administrative Proceedings. As permitted or required by state or federal law, the BGI Health Plans may disclose your protected health information in the course of any lawsuit or legal dispute to which you are a party. Such disclosure will only occur in response to an order of a court or administrative tribunal as expressly authorized by such order, or in response to a subpoena, discovery request or other lawful process, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested. If a BGI Health Plan is required to so disclose your protected health information, the BGI Health Plan will make reasonable efforts to notify you of the request and to obtain an order protecting the applicable health information.
For Law Enforcement Purposes. As permitted or required by state or federal law, the BGI Health Plans may disclose your protected health information to a law enforcement official for certain law enforcement purposes, including, but not limited to, if a BGI Health Plan has a suspicion that your death was the result of criminal conduct or in an emergency to report a crime.
In the Event of a Serious Threat to Health or Safety. The BGI Health Plans may, consistent with applicable law and ethical standards of conduct, disclose your protected health information if a BGI Health Plan, makes a good faith determination that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
To Family and Friends. The BGI Health Plans may disclose protected health information to a family member, friend, or other person involved in your health care if you are present and you do not object to the sharing of your protected health information, or, if you are not present, in the event of an emergency.
For Public Health Reasons. The BGI Health Plans may disclose your protected health information for public health actions, including (1) to a public health authority for the prevention or control of disease, injury or disability; (2) to a proper government or health authority to report child abuse or neglect; (3) to report reactions to medications or problems with products regulated by the Food and Drug Administration; (4) to notify individuals of recalls of medication or products they may be using; (5) to notify a person who may have been exposed to a communicable disease or who may be at risk for contracting or spreading a disease or condition; or (6) to report a suspected case of abuse, neglect or domestic violence, as permitted or required by applicable law.
For Specified Government Functions. In certain circumstances, federal regulations require the BGI Health Plans to use or disclose your protected health information to facilitate specified government functions related to the military and veterans, national security and intelligence activities, protective services for the President of the United States of America and others, and correctional institutions and inmates. In addition, the BGI Health Plans are required to disclose your protected health information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the Privacy Rules.
For Workers’ Compensation. The BGI Health Plans may release your protected health information to the extent necessary to comply with laws related to worker's compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Notwithstanding the foregoing, it should be noted that state law may further limit the permissible ways the BGI Health Plans use or disclose your protected health information. If an applicable state law imposes stricter restrictions on the BGI Health Plans, we will comply with that state law.
For Research Purposes. The BGI Health Plans may share your protected health information for research purposes where the only remuneration received by the covered entity or business associate is a reasonable cost-based fee to cover the cost to prepare and transmit the protected health information for such purposes.
To Respond to Organ and Tissue Donation Requests. The BGI Health Plans may also disclose your protected health information to organ procurement or similar organizations for purposes of donation or transplant.
For Coroners and Funeral Directors. Upon your death, the BGI Health Plans may release your protected health information to a funeral home director, coroner, or medical examiner, consistent with applicable law to enable them to carry out their duties.
For Business Associates. The BGI Health Plans may share your protected health information with certain business associates that perform services for us. The BGI Health Plans may disclose your protected health information to a business associate so that the business associate can perform the job we have asked it to do and bill you or your third-party payer for services rendered. Federal law requires us to enter into business associate contract to safeguard your protected health information as required by law and Barnes Group Inc.
For Sale of Protected Health Information. The BGI Health Plans may not disclose your protected health information to any other person in exchange for direct or indirect remuneration unless such disclosure is made to another covered entity for purposes of treatment or payment, or as otherwise authorized or required by state or federal law. In such instances, the remuneration we can receive for such disclosures may not exceed our reasonable costs for preparing or transmitting the protected health information.
AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION
Other than as stated above, the BGI Health Plans will not disclose your protected health information without your written authorization. As a participant of more than one BGI Health Plan, a separate authorization will be required for each BGI Health Plan to use or disclose your protected health information other than as permitted. If you authorize a BGI Health Plan to use or disclose your protected health information, you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding your protected health information that the BGI Health Plans maintain:
Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your protected health information. You have the right to request a limit on the BGI Health Plans' disclosure of your protected health information to someone involved in the payment of your care. However, no BGI Health Plan is required to agree to your request except in cases where the protected health information pertains solely to a service or item where the provider has been paid in full If you wish to make a request for restrictions, please send a written request to the address shown at the end of this notice.
Right to Receive Confidential Communications. You have the right to request that a BGI Health Plan communicate with you in a certain way if you feel the disclosure of your protected health information could endanger you. For example, you may ask that a BGI Health Plan only communicate with you at a certain telephone number or by email. If you wish to receive confidential communications, please make your request in writing to the address shown at the end of this notice. All BGI Health Plans will attempt to honor reasonable requests for confidential communications.
With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the BGI Health Plan, and includes mail with information on the use of BGI Health Plan benefits by the employee’s spouse and other family members and information on the denial of any BGI Health Plan benefits to the employee’s spouse and other family members. If a person covered under the BGI Health Plan has requested Restrictions or Confidential Communications, and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Right to Inspect and Copy Your Protected Health Information. You have the right to inspect and copy your protected health information. A request to inspect and copy records containing your protected health information must be made in writing. If you request a copy of your protected health information, please send a written request to the address shown at the end of this notice. A BGI Health Plan may charge a reasonable fee for copying, assembling costs and postage, if applicable, associated with your request. If your protected health information is maintained in an electronic health record, you may receive a copy of your protected health information in an electronic format.
Right to Amend Your Protected Health Information. If you believe that your protected health information records are inaccurate or incomplete, you may request that the relevant BGI Health Plan(s) amend such records. That request may be made as long as the information is maintained by a BGI Health Plan. A request for an amendment of records must be made in writing to the address shown at the end of this notice and must contain the reasons supporting the requested amendment. A BGI Health Plan may deny any request that does not include support for the amendment. A BGI Health Plan also may deny your request if your health information records were not created by the BGI Health Plan, if the protected health information you are requesting to amend is not part of the BGI Health Plan’s records, if the protected health information you wish to amend falls within an exception to the protected health information you are permitted to inspect and copy, or if the BGI Health Plan determines the records containing your protected health information are accurate and complete.
Right to an Accounting. Each BGI Health Plan is required to keep a record of certain disclosures of your protected health information under the Privacy Rule. These disclosures include disclosures for public purposes authorized by law or disclosures that are not in accordance with the BGI Health Plan's privacy policies and applicable law. You have the right to request a list of such disclosures from the BGI Health Plan. The request must be made in writing to the address shown at the end of this notice. The request should specify the time period for which you are requesting the information. Accounting requests may not be made for periods of time going back more than six (6) years. A BGI Health Plan will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests within such 12-month period may be subject to a reasonable cost-based fee. The BGI Health Plan will inform you in advance of the fee, if applicable.
Right to Receive Notification of Breaches. If unsecured protected health information is acquired, used or disclosed in a manner that is impermissible under the Privacy Rules and that poses a significant risk of financial, reputational or other harm to you, the BGI Health Plan must notify you without unreasonable delay and in no case later than 60 days after discover of such breach.
Right to a Paper Copy of this Notice. You have a right to request and receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To obtain a paper copy, please send a written request to the address shown at the end of this notice.
Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. The BGI Health Plans will take steps to verify the person indicated has this authority and can act for you before the person may exercise your rights and make choices on your behalf.
DUTIES OF BGI HEALTH PLANS
All BGI Health Plans are required by law to maintain the privacy of your protected health information as set forth in this Notice and to provide to you this Notice of its duties and privacy practices. Further, the BGI Health Plans are required to let you know promptly if a breach occurs that may have compromised the privacy or security of your information. All BGI Health Plans must follow the duties and privacy practices described herein and give you a copy of this Notice.
All BGI Health Plans are required to abide by the terms of this Notice, which may be amended from time to time. Each BGI Health Plan reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If a BGI Health Plan changes its policies and procedures, such plan will provide a copy of a revised Notice to you within 60 days of the change. You have the right to express complaints to the BGI Health Plans and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to the BGI Health Plans should be made in writing to:
Barnes Group Corporate Benefits Department
Barnes Group Inc.
123 Main Street
Bristol, CT 06011
Complaints filed with the Secretary of the Department of Health and Human Services should be made using any of the following methods:
U.S. Department of Health and Human Services Offices for Civil Rights
200 Independence Avenue, S.W.,
Washington, D.C. 20201
The BGI Health Plans encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
Each BGI Health Plan has designated the Corporate Benefits Department as the point of contact for all issues regarding patient privacy and your privacy rights. The address and phone number for the Corporate Benefits Department are cited above. The Privacy Official for the BGI Health Plan is Caroline Segar, Director, Total Rewards, who may also be contacted at
123 Main Street
Bristol, CT 06010
IF YOU HAVE ANY OTHER QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT BARNES GROUP INC.’S CORPORATE BENEFITS DEPARTMENT.